Some insurance payers require that you add modifiers to your claims or superbills. You can set modifiers to automatically populate and can also manually edit a claim to include a modifier. 

In this guide, we’ll cover:

• Enabling modifiers in your account
• Adding modifiers to individual appointments
• Setting a default modifier for a client
• Using modifiers in the SimplePractice mobile app
• Updating a claim or superbill to include a modifier
• Using modifiers for Telehealth appointments

Note: Modifier requirements vary by insurance payer. We recommend reaching out to your insurance payer(s) to check their requirements before submitting claims.

Enabling modifiers in your account

To enable modifiers in your account:

• Navigate to Settings > Client billing and insurance > Insurance documents
• Check the box next to Enable Modifiers for your practice

• Click Save changes

Adding modifiers to individual appointments

You can add modifiers to specific appointments from your calendar or from a client’s Billing page. This is recommended if you don’t typically add a modifier for a client’s appointments, but have a one-off need. 

Note: Adding a modifier to an appointment before creating a claim or superbill will add the modifier to the document when it’s created. If you need to update a modifier on a document after it’s created, see Updating a claim or superbill to include a modifier. 

To add a modifier to an appointment from your calendar:

• Click the appointment
• Enter the modifier in the field below the service

• Click Done 

Note: You can add up to 4 modifiers per service code.

Modifiers you add from the calendar will only apply to the appointment(s) you’ve edited. If the appointment is part of a recurring series, you’ll have the option to add the modifier to all future appointments in the series. 

To add a modifier from a client’s Billing page:

• Navigate to the client’s Billing page
• Click Manage > Edit details next to the appointment

• Add the modifier in the field under the appointment details

• Click Save

Important: Adding a modifier to an appointment won’t apply it to an existing claim or superbill. If you need to add a modifier to a claim or superbill you’ve already created, see Updating a claim or superbill to include a modifier.

Setting a default modifier for a client

You can set a default service code and modifier for a client so that all of their future appointments include the modifier. If you choose this option, you can still make edits to individual appointments if needed. 

To add a modifier to a default service code:

• Navigate to the client's Overview page
• Click Edit > Billing and Insurance
• Scroll down to Client Default Services and select a default Service Code from the dropdown
• Enter the modifier(s) in the Modifiers field

• Click Save Client

Using modifiers in the SimplePractice mobile app

You can add modifiers to appointments from the calendar through all versions of the SimplePractice mobile app, as long as this feature has been enabled for your practice through the web app. To do this: 

iOS

• Navigate to the calendar
• Select an appointment
• Tap Edit
• Select Services > Modifiers
• Enter your modifier(s) 

• Select the back arrow at the top left of the screen twice 
• Tap Save

Android 

• Navigate to the calendar and select an appointment
• Tap the pencil icon
• Select Billing > Modifiers 
• Enter your modifier(s) 
• Tap the checkmark
• Select the checkmark again to save all changes

Note: For more information about each version of the app, see Getting started with the SimplePractice Clinician app on iPhone and iPad and Getting started with the SimplePractice for Clinicians app.

Updating a claim or superbill to include a modifier

If a modifier is added to an appointment after a claim is created, it won’t be automatically added to the claim. To update the claim to include the modifier:

• Click Edit at the top of the claim
• Enter the modifier in box 24d

• Click Save

You can also delete the existing claim and recreate it, so that the modifier appears in the new claim.

Important: If a claim was denied due to an incorrect or missing modifier, see What to do when a claim is denied. 

If a superbill has been created for an appointment, a modifier can’t be added to the appointment or superbill retroactively. To update the superbill:

• Delete the existing superbill
  • If you’d like to keep a record of the superbill, you can download it as a PDF 
    • For more information, see Creating a superbill  
• Add a modifier to the individual appointment(s)
• Create a new superbill

The modifier will appear in the Service column:

Using modifiers for Telehealth appointments

The following modifiers are typically used to bill Telehealth appointments:

• If you're billing a commercial insurance payer, use 95
• If you're billing Medicare, use GT

You can assign one of these modifiers to your Telehealth location so that it automatically populates claims or superbills for those appointments. To do this:

• Navigate to Settings > Practice > Practice details
• Click Edit next to your Telehealth location

• Open the Telehealth modifier dropdown

• Choose 95 or GT 
  • If you don’t want a default modifier for the location, choose None
• Click Save

You can assign one of these modifiers, or none, for each office location you’ve added. 

Note: If a client’s default service code includes a modifier, it’ll override the location’s default modifier.

Requirements vary by insurance payer. We recommend reaching out to the payer directly if a claim is denied for the incorrect modifier, or if you’re unsure which modifier to use.